Provider Demographics
NPI:1245214220
Name:FIENGO, MARK N (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:N
Last Name:FIENGO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:164 OTROBANDO AVE
Mailing Address - Street 2:STE B
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2116
Mailing Address - Country:US
Mailing Address - Phone:860-443-4383
Mailing Address - Fax:860-443-3980
Practice Address - Street 1:196 PARKWAY S
Practice Address - Street 2:SUITE 103
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-1234
Practice Address - Country:US
Practice Address - Phone:860-443-4383
Practice Address - Fax:860-443-3980
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2020-03-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT00281207RI0011X
CT000281207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001002815Medicaid
CT060001285Medicare ID - Type Unspecified
F44098Medicare UPIN